Crime and healthcare reform consistently top public opinion polls as Americans' chief concerns, and both will top this year's congressional agenda.
But as lawmakers grapple with the two issues, it's unlikely that proposals seeking to curb violent crime and solve healthcare woes will be linked in any meaningful way.
Despite calls from some members of Congress to tax firearms and ammunition to help pay for healthcare reform-and proposals that might stem the toll violence is taking on hospitals-none of the healthcare reform initiatives mentions deterring violent crime.
According to veteran health lobbyists, greater restrictions and higher taxes on guns and bullets aren't likely to get very far in the context of healthcare reform, for fear of taking on the powerful gun lobby.
"I don't see that there's a whole lot of thought being given to the cost of violence to the healthcare system," said Stephen Cooper, vice president of the Health Care Association of New York State. The reason: "It's going to be hard enough to get healthcare reform through without taking on another fight," he said.
Last year, Sen. Daniel Patrick Moynihan (D-N.Y.) said he'd like to finance universal health coverage in part with a tax on ammunition. While Clinton administration officials didn't reject the notion, they downplayed it, saying it wouldn't raise much revenue.
Furthermore, a resolution that would have imposed such a tax-sponsored by Sens. Bill Bradley (D-N.J.), Patty Murray (D-Wash.) and Paul Simon (D-Ill.)-never got to the Senate floor for a vote last year. The measure raised concerns that it would dim prospects for a more stringent ban on assault weapons in the Senate's crime bill.
Only one reform proposal, the single-payer plan sponsored by Rep. Jim McDermott (D-Wash.) and Sen. Paul Wellstone (D-Minn.), includes a tax on guns and ammunition as a financing mechanism. The proposal, which has 92 co-sponsors in the House and five in the Senate, would impose a 50% excise tax on firearms and ammunition. According to estimates from the Joint Committee on Taxation, the measure would raise $1 billion by 1999.
While hospital representatives aren't optimistic about the inclusion of anti-crime initiatives in healthcare reform, they hope the final bill will provide adequate funding for facilities that treat the victims of gun violence.
"Most people affected by violent crime, whether it's the criminals or innocent victims, are uninsured," said Marcia Mabee, executive director of the Coalition for American Trauma Care, Reston, Va. While any healthcare reform plan that provides coverage for the uninsured would be an improvement, Ms. Mabee said, that doesn't ensure adequate financing for the trauma centers that treat these victims.
President Clinton has proposed deep Medicare and Medicaid cuts in his health plan, which could severely damage trauma-center funding if reductions aren't carefully synchronized with the phase-in of universal coverage, Ms. Mabee said. In addition, health plans should be required to contract with a qualified trauma center to make sure that patients continue to have access to those services.
Lawrence Gage, president of the National Association of Public Hospitals, said so much of the capacity of inner-city trauma centers is taken up with victims of violence that "it's impossible to ignore the impact."
Those engaging in violence will be the most difficult to "turn into informed consumers under the managed-competition nirvana" envisioned in the president's health plan, he said. As a result, those individuals "will remain outside the system no matter what we say or give them on paper."
To ensure that providers are adequately compensated will require far more than the $800 million annually that the Clinton plan would provide for vulnerable populations, he added. "I hope there will be a convergence of these political issues in Washington, so that some things can be done in the context of healthcare reform ... for providers who are on the front lines in this war," Mr. Gage said.